

This article is an excerpt from the Shortform summary of "The Checklist Manifesto" by Atul Gawande. Shortform has the world's best summaries of books you should be reading.
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In the 21st century, we can do things that were unthinkable not long ago. Yet highly trained, experienced, and capable people regularly make avoidable mistakes. You may be wondering, Why do I make so many mistakes?
After experiencing his own mistakes and observing those of colleagues, Boston surgeon Atul Gawande set out to learn why smart people make avoidable errors and, more importantly, to find a way to prevent them. The result is The Checklist Manifesto: How to Get Things Right, in which Gawande proposes a simple solution: a checklist. Learn how to use it to prevent yourself from making avoidable mistakes.
Why Do I Make so Many Mistakes?
Why do I keep making mistakes? In a 1970s essay on human fallibility, Samuel Gorovitz and Alasdair MacIntyre argued that in some cases we fail due to “necessary fallibility” — because we’re trying to do something humans are incapable of. Much of the universe is unknown to us; there are limits to what we can know and do.
Yet we also fail frequently in areas where we have control. Gorovitz and MacIntyre argued there are two reasons:
- Ignorance or lack of knowledge.
- Ineptitude, meaning we have the knowledge, but don’t apply it correctly.
Mistakes due to ignorance can be addressed with more education and experience. But knowledge doesn’t make a difference if we fail to apply it or do so incorrectly. An experienced meteorologist can miss signs of a storm’s likely behavior, or a skilled doctor can forget to ask a patient a critical question.
So, Why do I make so many mistakes? A combination of ignorance and ineptitude…but mostly ineptitude. Luckily, I can do something about this.
Ineptitude in Action
Surgeons like Gawande often tell each other stories of mistakes and near misses, puzzling over how they could have missed seeing something that turned out to be vital. For instance, a surgeon was removing a cancer of the stomach when, about halfway through the procedure, the patient’s heart stopped. The team couldn’t find any cause as they worked to resuscitate him and called for additional personnel and equipment. A senior anesthesiologist who’d been in the room earlier, before the patient had been put to sleep, arrived to help. He asked the attending anesthesiologist if he’d done anything additional since they’d last spoken. The doctor said yes, he’d given the patient potassium when lab reports arrived showing his levels were too low.
When the team dug the IV bag out of the trash, they discovered that the patient had been given the wrong concentration — a lethal dose. Through a variety of heroics, they managed to bring him back. The team was shaken: they’d had all the necessary knowledge and tools, but their ineptitude nearly killed him. Even doctors get things wrong, so don’t beat yourself up when asking yourself, Why do I keep making mistakes?
An Explosion of Knowledge and Complexity
In trying to do the right things, the challenge of the 21st century is ineptitude, rather than ignorance. It used to be the reverse. For most of human history, we struggled with scientific ignorance. We didn’t understand how things worked or what caused illnesses and how to treat them. This answered our question, Why do I make so many mistakes?
But while science has increased our knowledge dramatically, we still often fail. The reason isn’t lack of money, malpractice, or government or insurance issues. It’s the enormous and ever-increasing complexity of many fields today. We struggle to apply knowledge the right way at the right moment. Under pressure, we make simple mistakes and overlook the obvious.
For instance, authorities at all levels make numerous mistakes when disasters strike. Attorneys make mistakes in complex legal cases, most commonly administrative errors. We have foreign intelligence failures, cascading banking industry failures, and software design flaws that compromise the personal information of millions of people. Deciding the right treatment among the many options for a heart attack patient can be extremely difficult. Each one involves complexities and pitfalls.
Getting the right thing done is a challenge too. From research, we know that heart attack patients who will benefit from cardiac balloon therapy should have it within 90 minutes of arriving at a hospital. After that, survival rates drop. But a 2006 study showed less than a 50 percent likelihood that a medical staff could get everything done that needed to be done in less than 90 minutes. Similarly, at least 30 percent of stroke patients get insufficient care, and the same is true for 45 percent of asthma patients and 60 percent of pneumonia patients. Knowing the right steps and trying hard aren’t enough.
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- How checklists save millions of lives in healthcare and flights
- The two types of checklists that matter
- How to create your own revolutionary checklist